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Pediatric Palliative Care Fellowship

The Pediatric Advanced Care Team at The Children's Hospital of Philadelphia is offering a one-year clinical fellowship to train physicians in pediatric palliative care. Through the duration of the year the fellow will be asked to:

Provide direct patient care in both inpatient and outpatient settings

Participate in a didactic education plan of lectures, clinical conferences, and a regular journal club

The program is designed for one trainee beyond the PGY 3 level and can accommodate candidates completing a residency in pediatrics or subspecialty fellowships at the appropriate PGY level.

Completion of this fellowship will prepare physicians to become board-certified in the subspecialty of Palliative Care, as well as to become leaders in the provision of palliative, end-of-life, and bereavement care.

The Children's Hospital of Philadelphia and the Perelman School of Medicine at the University of Pennsylvania are ideally situated to provide leadership and outstanding training in the emerging domain of pediatric palliative care.

The Children's Hospital of Philadelphia has developed one of the largest pediatric palliative care services in the country — with one of the largest, most interdisciplinary teams — averaging more than 130 new patients each year.

The attending physicians who direct the program and oversee care represent many subspecialties and include two physicians certified by the American Board of Hospice and Palliative Medicine. The director of research for the team has had continuous federal research funding for the past 6 years to profile the needs of dying children and is recognized as a leading researcher in pediatric palliative care.

The team is also thoroughly involved in the training of pediatric resident physicians at The Children's Hospital of Philadelphia and medical students at the University of Pennsylvania.

Applicant qualifications: The program is designed for one trainee beyond the PGY 3 level. The program will accommodate excellent candidates completing a residency in pediatrics or pediatric subspecialty fellowships at the appropriate PGY level.

Qualifications upon completion of training: At the completion of the training, the fellow will be qualified to take the board examination for certification in Hospice and Palliative Medicine; to develop and lead pediatric palliative care clinical teams; and to pursue the next step in their academic career.•

The primary clinical experience will be with the Pediatric Advanced Care Team. In an effort to provide exposure to a diverse range of both pediatric and adult patients, the fellow will have additional core rotations within The Children's Hospital of Philadelphia and the Hospital of the University of Pennsylvania, our neighboring adult hospital. Finally, the fellow will perform a Capstone project relevant to their specific interests in pediatric palliative care.

Core rotations

Pediatric Advanced Care Team

The Pediatric Advance Care Team (PACT) is an interdisciplinary team that includes physicians from general pediatrics, oncology, neonatology, pulmonology, anesthesiology and critical care; as well as staff from nursing, social work, chaplaincy, child-life and bereavement support.

The service offers consultation services for patients and families at the request of the patient, the family, or any member of the healthcare team. The goal of care is to:

Improve end-of-life care for children

Help families make difficult decisions

Support a family's values and preferences

Treat and eliminate symptoms common at the end of life

Provide emotional and spiritual support to the child, family and healthcare team

Arrange for home care and hospice services

Following initial consultation, the children and families are offered ongoing, longitudinal involvement from PACT. In addition to the direct patient/family involvement, PACT works with other healthcare providers and hospice agencies to build a supportive network of care spanning the child's life and death.

The role of the fellow will transition quickly from participant observer to primary physician contact, always with the direct supervision and guidance of the attending PACT physician. Specifically, this clinical experience involves daily clinical rounds, bi-weekly interdisciplinary team rounds, phone consultations throughout the week, and home visits when appropriate. All cases are supervised, reviewed and discussed with the fellow on a daily basis.

Integrated Care Service

The Integrated Care Service (ICS) is an acute inpatient pediatric unit for children with complex, life-threatening medical conditions that require the coordinated care of many specialties and disciplines.

The core ICS healthcare team consists of an attending physician from general pediatrics, five pediatrics residents, a nurse practitioner, a social worker, a case manager, and floor nurses -- all working with the patient and family to optimize the patient's health status and quality of life.

The responsibilities and experiences of the team typically involve diagnostic evaluation within the context of established chronic illness, the development and implementation of comprehensive care plans within the context of family and home capacity, and the assessment of treatment within the context of patient comfort and quality of life.

The fellow will provide patient care, family counseling, and residency training under the direct supervision of the ICS attending physician. The fellow will participate in daily interdisciplinary bedside rounds with the full ICS team and care coordination rounds with the social worker, nurse educator, and case manager.

Wissahickon Hospice

Wissahickon Hospice is administered through Penn Home Care and Hospice Services, which is an affiliate of the University of Pennsylvania Health System (UPHS). It is staffed by UPHS clinicians and provides interdisciplinary HPM services for adult patients in home, hospital, rehabilitation, and chronic care settings.

The team includes physicians, social workers, nurse case managers, nurse practitioners, and chaplains focused on symptom management, guidance in medical and legal decisions, skilled nursing, bereavement support, and spiritual care.

The Wissahickon Hospice rotation consists of four two-week blocks. In the first block, the fellow spends two weeks providing hospice care in the home hospice setting supervised by a family medicine physician, in collaboration with a nurse case manager, chaplain, and psychosocial clinician.

In the second block, the fellow provides care on a dedicated inpatient hospice service for adults with end-of-life conditions supervised by the attending physician and in collaboration with a nurse case manager, chaplain, and psychosocial clinician.

In the third block, the fellow provides hospice consultation in a nursing home, rehabilitation and chronic care setting under the supervision of a geriatrics physician and in collaboration with a nurse case manager and psychosocial clinician.

In the last block, the fellow spends two weeks providing multi-site (e.g., hospital, nursing home, patient home) palliative care consultation to patients still pursuing life-sustaining therapies. Each week, the fellow participates in the team coordination meeting specific to the clinical block.

Psychosocial rotation

During time spent on PACT consult service, the fellow works directly with social work, bereavement, child life, art therapy, chaplaincy, and family faculty of PACT to gain specific experiences that make up a comprehensive pediatric palliative care model. This rotation includes direct patient care and informal discussions of the goals of the patient interactions.

The social worker works with healthcare workers and school systems in coordinating psychosocial services, providing psychosocial and emotional support for patients, families, and healthcare workers working with dying children.

The bereavement coordinator provides educational services to families and staff and organizes a memorial service and candle lighting ceremony. Also, in collaboration with the social worker, they provide a six-week bereavement support group and coping workshop that the fellow attends.

The child-life specialist and art therapist provide social, emotional, and developmental support to children and families by utilizing developmentally appropriate play, art, education, counseling, and legacy building activities while creating opportunities for memory making.

The chaplain provides pastoral services for families from a diverse group of spiritual beliefs and religions, including spiritual interventions, support, prayer and sacraments. The chaplain assists with ethics consultations, coordinates spiritual care with communities of faith, and arranges any special spiritual needs of a patient and family.

The family faculty supports and creates programming for families, teaches staff about the family experience, develops strategies for communication and care, and brings a family perspective to committees. As an advisor to PACT, they collaborate in patient care and strategic planning.

Home hospice experience

Through the Partners Program, a collaborative effort with hospice agencies in the greater Delaware Valley and the Pediatric Palliative Care Program, the fellow works with hospice agencies and nurses that provide end-of-life care in the child's home environment.

This experience occurs while the fellow is rotating with the PACT team, though the fellow works directly with hospice agencies not directly affiliated with the PACT team.

Primarily, this experience is observational with the fellow learning -- through direct patient care -- the issues that face a family in non-acute environments with limited resources. While working primarily with the hospice nurse, the fellow interacts with the hospice's team as they interact with each patient. When available, the fellow attends the hospice's team rounds.

Pain Team: Consult service

The Pain Team is a multidisciplinary team that offers specialized evaluation and treatment of acute and chronic pain. The team sees about 1,500 consults per year, including post-operative pain, chronic pain conditions, acute non-surgical pain, and opioid/benzo dependence.

The fellow will gain experience in the use of patient-controlled analgesia, continuous epidural analgesia, peripheral nerve blocks, intrathecal morphine, and oral analgesic therapy. The fellow will not be asked to perform procedures but will learn the methods used, how they work, what medications and doses are employed, and any related complications.

Though there is an outpatient component available, the majority of this clinical experience will be inpatient. While on this service, the fellow will be the primary contact for all consultations and evaluations. Supervision will be provided by the Pain Team anesthesiologist.

Oncology/Palliative Care Clinic

This clinic is geared to evaluating symptom management and discussions of decision making over the course of the child's illness. It is organized through the division of oncology, supervised by the director of the Pediatric Palliative Care Program (an oncologist), and includes a team of nurses, social workers, and child life therapists. While the clinic primarily sees children with oncologic diagnoses, other patients with life-threatening diseases are seen as well (active patients involved with PACT).

The fellow participates in the clinic on a weekly basis while on the PACT rotation. The goal is to enhance the fellow's ability to follow patients longitudinally through the course of their illnesses, provide education on some disease processes common to hospice and palliative medicine, and expose the fellow to how an interdisciplinary team approaches care in an ambulatory setting.

Capstone Project

The fellow will identify an area of interest in pediatric palliative care and comprehensively review and summarize the topic. The project will start within the first two months of the fellowship and will include a literature review, summary of findings, and evaluation of areas for improvement. The project will be presented to the PACT team. The fellow will also be supported in pursuits to publish the information.

In lieu of a capstone project, the fellow will be allowed to pursue a limited research project in the identified area of interest. Mentorship will be provided to insure the project scope is reasonable for the time allotted.

Elective rotations

Sub-specialty clinic experience

Children with life-limiting illness are cared for by many subspecialty services. In an effort to provide exposure to the natural course of many of these illnesses, as well as knowledge on some of the common therapies for prolonging life and minimizing symptoms, an experience will be offered as a collection of sub-specialty clinics.

The content of each will be specific to that clinic and the disease processes seen by them. All will focus on the longitudinal care and symptom management of diseases common to the specialty, as well as the psychosocial stressors common to the patient base.

Given the subspecialty experience needed to care for these patients, the fellow's role will primarily be observational. However, the fellow will provide direct patient care supervised by the sub-specialty physician.

Ethics Committee: Consult service

Understanding the ethical and legal aspects of palliative care is an integral part of understanding how to affectively provide comprehensive palliative care to patients. While the fellow will gain exposure to these issues as they pertain to palliative care throughout the fellowship, the elective will provide a more global experience in the ethical dilemmas common to the care of children in a large pediatric hospital. The elective will include a reading list a discussion about specific cases that cover ethical and legal topics related to palliative care.

Research in Pediatric Palliative Care

This elective is meant to augment the capstone project if the fellow chooses to do a research topic. Due to the nature of research and the difficulty of achieving a meaningful experience in a short period of time, this elective will provide time for the intensive phase of setting up the project. The experience will then continue through the year until the completion of the project. Progress will be supervised to guarantee a meaningful experience.

New elective experiences

In addition to these elective experiences, every effort will be made to set up new electives that accomplish goals consistent with the mission of the fellowship program and address the specific interests of the fellow.

The didactic component of the Pediatric Palliative Care Fellowship is designed to augment the clinical experience, as well cover topics not traditionally found in a clinical setting. The program will focus on:

The epidemiology and pathophysiology of progressive chronic illnesses in people of all ages

The management of these diseases in multiple clinical settings

The psychosocial issues associated with death and dying

Emphasis will be placed on communication and team building skills. The program will consist of a conference series, a formal lecture series, round table discussions, and a journal club.

Conferences will be supported by physician faculty from both The Children's Hospital of Philadelphia and the Hospital of the University of Philadelphia

Conference series

The conference series will provide the fellow with the opportunity to learn — in a case-based or didactic forum — the epidemiology, pathophysiology and natural history of many chronic illnesses across multiple disciplines in pediatric palliative care.

A highlight of these conferences include:

Pediatric Advanced Care Team Clinical Conference (weekly)

The Pediatric Advanced Care Team meets for a multidisciplinary conference to discuss the clinical and ethical aspects of patients care.

Fellowship/Leadership Conference: The University of Pennsylvania and the Children's Hospital of Philadelphia (weekly)

This conference is meant to foster skills that are essential to be a successful leader in any medical field or large institution. The skills stressed in this series will be valuable to foster institutional change and be a leader in the growth of pediatric palliative care.

Lecture Series (varies)

The formal lecture series will focus on both pediatric and adult topics specific to palliative care. The intent of this series is to provide a basis for the year and will be given in the first two months of the fellowship.

Journal Club (monthly)

A journal club will be sponsored by PACT. Topics will be presented monthly and will focus on clinical aspects of pediatric palliative care and on interpreting the medical literature. The fellow will be responsible for presenting topics at least four times during the fellowship.

Teaching experiences (varies)

In an effort to develop communication and teaching skills, the fellow will be expected to lead patient discussions at the weekly PACT conference; lecture as part of the palliative care resident lecture series; and provide bedside teaching to the medical students, residents and nurses involved in either the pediatric palliative care elective or in direct patient care.

Our program number is 5404132013. We do accept international medical graduates from AAMC-approved medical schools; and we support J and H1-B visas.

HPM Match Timeline for fellow starting in July 1, 2016

If you are interested in applying for a position in our upcoming 2016 fellowship class, please follow this timeline:

ERAS registration: Spring 2015

NRMP online program information update: May 1, 2015

ERAS opens: July 1, 2015

Match opens: July 29, 1915

Rank list opens: Sept. 30, 2015

Quota change deadline: Oct. 28, 2015

Rank list deadline: Nov. 11, 2015

Match day: Dec. 2, 2015

ERAS closes: May 1, 2016

Fellow start date: July 1, 2016

We encourage open communication with the program director and coordinator throughout the application process. If you are considering applying, please email your CV to the Program Director or Coordinator so we can double check that we receive your application in ERAS (this is not a requirement for application however).

Instructions for application

The following information hould be submitted to ERAS:

Complete application as provided through ERAS

Personal statement: Please include a single page statement describing the following: your interest in pursuing training in pediatric palliative care; the goals you hope to achieve in training; and your plans after fellowship.

Curriculum Vitae

Three letters of reference

Dean's letter from medical school

Medical school transcript

Recent photograph

Copy of parts 1, 2 and 3 of the USMLE, taken within the seven-year time frame as required by the Commonwealth of Pennsylvania, or equivalent scores

If a graduate of a medical school outside the United States, Canada or Puerto Rico, valid ECFMG certificate or one that does not expire prior to the start of the fellowship

If not a citizen of the United States or permanent resident, copy of current, appropriate visa

To help preserve and improve the health of our patients, their families and our employees, The Children’s Hospital of Philadelphia has a tobacco-free hiring policy. This policy applies to all candidates for employment (other than those with regularly scheduled hours in New Jersey) for all positions, including those covered by the Collective Bargaining Agreement.

Job applicants who apply after July 1, 2014 will be expected to sign an attestation stating they’ve been free of nicotine or tobacco products in any form for the prior thirty (30) days. They will also undergo a cotinine test as a part of the Occupational Health pre-placement drug screen administered after the offer of employment has been accepted but before the first day of hire.

Exemptions: Attending physicians (excluding CHOP physicians in the Care Network), psychologists, principal investigators and/or Penn-based faculty are exempt from this process to better align with our colleagues at the University of Pennsylvania Perelman School of Medicine.